Epidemiology and clinical impact of chronic obstructive pulmonary disease in patients with atrial fibrillation: findings from an european prospective observational registry

Abstract

Abstract Background The interplay between atrial fibrillation (AF) and chronic obstructive pulmonary disease (COPD) has been poorly investigated and understood, with previous studies reporting unsatisfactory management and poor prognosis of patients with AF and COPD. Purpose To describe the epidemiology, management and natural history of AF patients with COPD using a contemporary European prospective cohort. Methods From a European-wide prospective observational AF registry, we identified patients with COPD as reported by the investigators. We analysed the association between COPD and the odds of receiving oral anticoagulants (OAC) and other pharmacological treatments using multivariable logistic regression models. We also assessed the associations between COPD and risk of major outcomes using multivariable Cox-regression models. Our primary outcome was all-cause mortality; secondary outcome was the risk of major adverse cardiovascular events (MACE). We finally evaluated the interaction between disease-specific treatments for COPD and the risk of major outcomes in AF-COPD patients. Results A total of 10,219 AF patients were included in this analysis (mean age 69.2 ± 11.4 years; 40.3% females); COPD was found in 909 patients (8.9%). Patients with COPD were older, more likely males, and had a higher burden of thromboembolic and bleeding risk factors. No differences were observed in the likelihood of receiving OAC or non-vitamin K antagonist oral anticoagulants (NOAC) in COPD vs. no COPD patients (OR: 1.00, 95%CI: 0.81-1.24, and OR: 0.91, 95%CI: 0.77-1.06, respectively for OAC vs. non OAC and NOAC vs. VKA prescription). Patients with COPD were less likely treated with ACE inhibitors, beta-blockers, amiodarone and class IC antiarrhythmics, while they showed higher odds of receiving diuretic, digoxin, and non-dihydropyridinic calcium channel blockers (Figure 1). Over a median follow-up of 24.3 [IQR: 23.0-25.0] months, the risk of all-cause death was higher among COPD patients (HR: 1.52, 95%CI: 1.28-1.80), as well as the risk of MACE (HR: 1.49, 95%CI: 1.22-1.83) and the composite outcome of ‘all-cause death and MACE’ (HR: 1.50, 95%CI: 1.29-1.74) (Figure 2). No statistically significant interactions were observed between the use of beta-blockers, beta-2 agonists and anticholinergic drugs, and the risk of death in COPD patients. Conclusions COPD was common in AF patients and was associated with higher prescription of rate-control (except for beta-blockers) and lower prescription of rhythm control drugs, with no differences in OAC treatment. COPD was associated with worse prognosis, without significant interaction observed for beta-blockers or other COPD-specific treatment.Figure 1Figure 2